Challenges Facing ASCs
Matching ASC codes with surgery codes is essential for proper ASC coding.
By Chris Felthauser, CPC, CPC-H, ACSOH, ACS-OR
Multispecialty freestanding ambulatory surgical centers (ASCs) are one of the fastest growing markets in health care today. Many physician groups are taking on the challenge of opening up their own surgery centers. This can lead a practice to a whole new set of coding challenges.
Coding for freestanding ASCs differs from physician or hospital coding. The guidelines aren’t quite so clear and coders can find a variety of answers to the same questions. How do we do it?
The biggest thing I tell people is to communicate with your carriers. Some carriers have published specific ASC coding guidelines, while others have relied on copying Medicare’s rules and regulations.
One challenge that ASC coders often face is how to match your ASC coding to the codes that the surgeon reports. Most ASCs have their own billing and coding staff. Many insurance carriers will deny the ASC’s charges if they do not match the surgeon’s bill. They consider the surgeon’s bill to be accurate regardless of the documentation that is sent in by the ASC. It is then up to the ASC’s coder to contact the surgeon’s office and come to an agreement on the proper coding of services. This can be a challenge.
Still, many surgeons’ offices do not employ coders for themselves, but instead their billers will code and bill for services that the physician scheduled. Most ASCs have the policy, and rightly so, to wait for the surgeon to dictate the operative report and code directly for the services documented. This allows the ASC to code accurately based on what was documented, and to capture all services, including implants that were used during the surgery that may be billed from the ASC. If there are any questions as to what the surgeon has billed versus what was documented, the coder can easily clarify this information with the physician.
Medicare requires all ASC charges to be filed on the CMS-1500 form electronically. The majority of other carriers require the use of the UB92 form. Medicare also requires that ASC submit its charges using modifier SG. Modifier SG indicates services were performed in an ASC. Many private payers also like to have the modifier SG on the claim, as it helps them distinguish between the physician’s bill and the facility’s bill. However, this may not be a requirement with every insurer, so it again is important to communicate with your carrier regarding its guidelines.
To learn more about ASC coding guidelines, download information directly from the Centers for Medicare & Medicaid Services (CMS) website. You’ll find the ASC coding information in chapter 14 of the Internet-only manuals.
Chris Felthauser, CPC, CPC-H, ACS-OH, ACSOR, is a coding consultant with The Coding Source (www.thecodingsource.com).